HomeMy WebLinkAbout0223 REGENCY DRIVE - Health 223 Regency Drive
Marstons Mills
r n a naa
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i
1 own of Barnstable O Lr— M
u
Regulatory Services
Thomas F.Geller,Director
� a�uextr�eu.
f�a ]Public Health Division
Thomas McKean,Director
200 Matnm Street,Hyannis,NIA 02601
Office; 508-8624644 Fax; 508-790-6304
Installer& Designer Certification Form
Date:
Designer: 5C: �1e'tneee�n�. 1nC Installer: 0,1s( ie 54 A4iy
Address: 2.8,59 CCoY%verC4 wl �Wov Address: �ok ` fI-
On h-voQ°���W g'f407 was issued a permit to install a
(date) (installcr)
septic system at 223 (LZ D(;ve ( based on a design drawn by
(address)
�C v��ineertr�� h C dated_ 4 2Op S
(designer)
/
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e,
greater than 10' lateral relocation'of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow.
a�
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ipNN�CNUN4µ166
lnsta '9 i attire) L
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( igner's I e ( ix Desi r' Stamp Here)
'PLEASE RET TO BARNST LE PU H N. CER FIC
F11 X VirV WIT
LL NOT BE I -SIZW=
THIS F -ASAME RE D BY TH& f!ARNST BLE PIM-L—IS-HEALT11 DIVISION.
THANK YOU.
Q HeAWSegtiODesigner Certification Form
TO 'd L9£0 £LZ S0S ON'IN33NION33r Wd TO= TO 900Z-90-N"r
r ' TOWN OF BARNSTABLE 6C
LG 'ATIt'�'N a 3 kZa%frL4 DTt ue- t SEWAGE # .7 005
VIILAGE?' 1tt'sn s" rYl 115 ASSESSOR'S MAP & LOT y"
�. n
INSTALLERS NAME&'PHONE NO. �:tis `�.(� t�i'Fa^-r
SEPTIC TAN`K'CAPACITY` 1500 G,e i A—t,,k f DOa q j .nvMQ C]tk+n1 e.r
LEACHING FACILITY: (type)?S��S'o0 R4 L.0 . (size) iy tY
NO. OF BEDROOMS
BUILDER OR OWNER 1—ak 6e, �cw�c��t2rr
PERMTTDATE: I / 3/ (? COMPLIANCE DATE: i' U �
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Wtv .N► &wiek-Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(I any wetlands exist
within 300 feet of leaching facility) eet
Furnished by 6 i j
Ced,
e3) too&-
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No. 5 (. f .. ,
° _ ' `I Fee 1
t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for ;Migogal *pgtem Cow6truction Permit
Application for a Permit to Construct( . )Repair 0()Upgrade( )Abandon( ) El Complete System WIndividual Components
Location Address or Lot No. Z213 R.Qiev-,e.y Drtaue- Owner's Name,Address and Tel.No. L�Gjvlb� 5�
Assessor's Map/Parcel (Irl T qc( �C4 o ✓fir r�/ �
& I,P
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f"DF,9-2 l 0 3 77
QOvS Fte fd Ste►-►�h'a�,� S'v��t.�.. �N� � e
v(.)x qq2r-4,e3J-4L204&44 2�"S''F� bc'My k-L"y
'2_010 E WcMc C,2 r?
Type of Building: 1
Dwelling No.of Bedrooms t'1 Lot Size�sq,ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures,ram'
Design.Flow gallons per day. Calculated daily flow �� gallons.
Plan Date f —?�-43' Number of sheets Revision Date Wo Ar JL_
Title
Size of Septic Tank /;5'bG� �.Frs¢ia.a Type of S.A.S. L-ec,cl e,AAyj-e,1-t' S-610 g&,r 7
Description of Soil: See _el'I",
Nature of Repairs or Alterations(Answer when applicable) Ak 'gCe_ A
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with,the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this 4 f Health.
'gned Date /— —6
Application Approve Date
Application Disapproved for the following reasons
Permit No. -=QW!5 Date Issued
^ `4 `
No: F- -+v�cJ" +r D: `_ .. , al �- " Fee
f }�' t Entered in computer: !
THE COMMONWEALTH OF MASSACHUSETTS Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
rication for Mio ool bpotem Cougtruction Permit
Application for a Permit to Construct( • )RepairX )Upgrade( )Abandon( ) ❑Complete System X Individual Components
Location Address or Lot No.?_Z 3 9 e�� lit i r/4- Owner's Name,Address and Tel.No. lr -PCt'1 per -54f k46P r
Assessor's Map/Parcel �� r "` _�I r„t e,5.�A,.,r/W If 47,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5_0F a 7 3 0?T
dVS �E' (cl Si�n,kAi� �C?rc/rce :wc- -J"C —evict .
1�ox r,�g2r-�r�3�-c��le oz6�.( ZrS'! C,r��bplry �Wy
W-2 o/o EA 5-74, ,4 �� 6 2.r?F-
Type of Building:
Dwelling No.of Bedrooms "7 Lot Size OgP�l 7(oy, sq.ft. Garbage Grinder )
Other : Type of Building Smg_(O A� fffra 4 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow. tk D% V gallons per day. Calculated daily flow f Q gallons.
Plan Date F-O Number of sheets / Revision Date AtoA.. JL
Title"
- Size of Septic Tank .5Z10 fg-: Type of S.A.S. t-E'c c-4 6o1A wA_41it S60 S'4&1
Description of Soil -^SEe O/,n ' a
f
Nature of Repairs or Alterations(Answer when applicable) 0(4C,e (--a r lA d t' `1;�- rp, r(, Or-r�
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with,the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by�thisoardof Health.
igned _ Date
Application Approve&by Date
Application Disapproved for the following reasons
Permit No. R; Q Date Issued 1 i 'a-3
---------------------------�,-----------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired (A-' )Upgraded( )
Abandoned( )by '80c.6 r-+e 0 SA.1.4-A,-u SPi y/(Q 2/Nt.
at 2 Z 2 o,, en c ,r -e- k^5 M, 1(5 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. _Wo S 5 R \dated ►�1''� —
Installer gyJAP IJ SAvif-�4;� / Designer cl"[
The issuance of this permit shall not be ponstrued as a guarantee that t ersyste fl unction as designed,
Date 1°� Inspectr
No. J ! Fee AT3
THE COMMONWEALTH OF MASSACHUSETTS n.
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Digool *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair(r )Upgrade( )Abandon( )
System located at 3 _c, eei c_car�,D r r.�� lrl/�.is �vir<, AA, �/S
t
i
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following 1 c I provisions or special conditions.
Provided: Construction must be completed within three years of the dat off th'iss- rmit.
Date:_ 1\ a I - Approved 6y
, A
i
t0'WI1 of Barnstable
Regulatory Services
i Thomas F.Geller, Director
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office; 508-862-4644 Fax, 508-790-6304
Installer&Designer Certification Form
Date:
Designer: C: tl neec�r1�, . 1nG. _ Installer: 0L/Sr ee J;"4,a,,zK ��`���� _e 7.vc
Address: ? `i C`onlncrcy WCJ� wnz Address: Lqo k y-f i
. warehl , MH
Gtu
On }(date) (insta,2 Qo_"4 l(/ 6-Ifcr�'re /r 7 was issued a permit to install a
- A
septic system at 2 3 �2.;e�c r t v Cased on a design drawn by
(address)
SC n inaecia�g , +n . dated-- 12r� I H . 2 ot►
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box andJor septic tank.
I certify that the septic system referenced above was installed with major changes (i.e,
greater than 10' lateral relocation'of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow.
C�U�CHtt►.
Insta 's i ature) J t
i
f ( rgner's I e ( ix Desi r' Sti:unp Here)
P1.EAS1E RET TO BAR STA LE PUL NON. CERTIFICATE
y F CQ=IANCE WILL NOT BE I T H 5 F S_
BUILT ARD ARE RE D BY HETL,E LI N.
THANK OIU.
Q,Hea1WSep:ic/Dnigner certification Form
T0 'd )-9£0 £j' Z 80S DNIN33NIDN33r Wd 10: T0 900Z-90-N"f
TOWN OF BARNSTABLE
LOCATIOi1-�— �ii C e� e�/fir; VO- SEWAGE S
VILLAGE ASSESSOR'S MAP&PARCEL
fM5WeL- S t NAME&PHONE NO. r iC,IC OL o mrd I
SEPTIC TANK CAPACITY /S 30
LEACHING FACILITY.(type)C� l Chc �S (size) �j GD
NO.OF BEDROOMS
OWNER
PERMIT DATE: C I V�I)ATE:`To 2
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
O -Hydrant F
Regency Drive
• 52 '
ss
Water 53
Service
s
• Rel.Wall �
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35 18 _
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Commonwealth of Massachusetts '
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
223 Regency Drive, Marstons Mills.MA 02648
Property Address
Eleanor Sandler DO - ON
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Impotent: A. General Information
When filling out
forms on the
computer,use 1. Inspector:
only the tab key + - -
to move your Patrick M. O'Connell
cursor-do not use the return Name of Inspector
key. Septic Inspection Services Co.
Company Name
189 Cammett Road
Company Address
Marstons Mills MA 102648 , :zS
Cityrrown State ip Code
508-428-1779 SI 12855 , c
f Telephone Number F; , License Number. 1 � -
B: Certification _
r r" l
I certify that I have personally inspected the sewage disposal system at this address an that thq-
information reported below is true, accurate and'complete as of the time of the inspectio . The irfs3ectio
was performed based on my training and experience in the proper function and mainten nce of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
hI Needs Further Evaluation by the Local Approving Authority
June 6, 2008
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
08-144 Sandler.doc•08/06 Title 5 Official Inspection Form:Subsurface,Sewage Disposal System-Page 1 of 15
I
ge
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
..'' 223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99_60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
InspectGon Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
Tank is not in need of pumping at this time, pump and alarm are in working order. Leaching
chambers have no standing water or sidewall stains.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined," please explain.
❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
08-144 Sandler.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
Commonwealth of Massachusetts
Title 5- Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008 `
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment. .
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within }
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
08-144 Sandler.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
® Liquid depth in cesspool is less than 6" below invert or available volume is less
than_day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
08-144 Sandler.doc 00/06 Title 5 Official Inspection Form:Subsurfacg Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
223 Regency Drive Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
08-144 Sandler.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99_60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened; and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15:302(5)]
08-144 Sandler.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street Chestnut Hill MA 02467 June 6 2008
every page. Cityfrown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: Unknown
Does residence have a garbage grinder? ® Yes ❑ No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ® Yes ❑ No
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: CurrentlyOccupied
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
08-144 Sandler.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
"t 223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: None
--
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Compliance Date: 12/19/05
Were sewage odors detected when arriving at the site? ❑ Yes ® No
08-144 Sandler.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 1'feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 1'feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
--------------------------------------------------------------------------------------------I-----------------------------
Dimensions: 10.5' long x 5.8'wide- 1500 gal.
Sludge depth:
2"
Distance from top of sludge to bottom of outlet tee or baffle
30"
Scum thickness
1"
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
13"
How were dimensions determined? Measured
08-144 Sandler.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection
spect on Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99_60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. City1rown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Liquid level in tank was found at bottom of outlet invert, outlet tee has been fitted with an effluent filter
which needs to be cleaned periodically.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of Past pumping: Date
Comments,(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
08-144 Sandlecdoc-08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
il
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
No solids or high stains present. Liquid level at bottom of all outlet pipes.
Pump Chamber(locate on site plan):
Pumps in working order: ® Yes ❑ No
Alarms in working order: ® Yes ❑ No
08-144 Sandler.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street Chestnut Hill MA 02467 June 6, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Floats are properly positioned, pump and alarm are operable.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: Five 500 gal
drywells.
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,.damp soil, condition of
vegetation, etc.):
Chambers have no standing water or sidewall stains.
08-144 Sandler.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
4 . Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r 223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth-pop of liquid to inlet invert --
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions -
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
08-144 Sandler.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
• Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
rt 223 Regency Drive Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
required for
every page. City[Town State Zip Code Date of Inspection
D. System Information (cont.)
O Hydrant
Re tency Drive
52 56
Water 53
Service
56
Ret. Wall
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \
/ / / / / / ! / / / /% % %
% / I%/
%
%
%
%
%
/%/ / /
35 18
32
38
` Commonwealth of Massachusetts
: Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
223 Regency Drive, Marstons Mills MA 02648
Property Address
Eleanor Sandler
Owner Owner's Name
information is required for 99-60 Florence Street, Chestnut Hill MA 02467 June 6, 2008
every page. City[rown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to ground water: 30
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Level of pond at rear of property is considerably lower than SAS.
08-144 Sandler.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15
Town of Barnstable
oF1He r�
,P' a Regulatory Services
BAMSTASLE, i Thomas F. Geiler, Director
1639. °'� Public Health Division
ATFo nay
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number of
bedrooms approved at a particular property would be listed on the "Disposal Works
Construction.Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
Q:\SEPTIC\Disclaimer Private Septic[nspections.DOC
o
LOCATION ' 3 SEW&CIE PERMIT UO.
IWSTALLER 5 W&ME ADDRESS
LDfjs',TlE
DER 5 t�l AI.�IE ADDRE SS
c%q—PERNAIT ISSUEDE COMPLI &MCE ISSUED : .— — - -
U
q
1
to
r .
No......................... ;EX ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......0 F.Z ...............................
Appliration -for Utspuiial 10orbi Tonstrurtiou Vrrnift
Application is hereby made for a ermit to Construct or Repair an Individual Sewage Disposal
System at: 4_aermit I
..................................... ............. ...... ......
- ------- - ...
E.c�,X-7Ad're;s or Lot No.
....... ... ........................ ..................................................................................................
Address
........................ ..................................................................................................
nstaller Address
U
Type of BuildingSize Lot............................Sq. feet
Dwelling—No. of Bedrooms__.__!;t-j............;---------_----------Expansion Attic Garbage Grinder
Other—Type of Building ---------------------------- No. of persons...___._.._.___......._...._ Showers Cafeteria
aOther fi tjUres -------------------------------------------------------------------------------------------------------
< x --------------------------------------------
Design Flow_______________46 ..............
W --------- --- -gallons per person per day. Total daily flow............J.0 ......... --gallons.
9 Septic TZLnk-L Liquid capacity. Length________________ Width..____._....._.. Diameter-_......_..____. Depth.-_.____..._--.
x Disposal Trench ----------- Width----------]Y1.14---- Total Length____________________ Total leaching arca----------- .....sq. ft.
Bepth bel I
Seepage Pit T Q--------1�-----------
........ Diameter.._/)R9._9____' ol in�6,_,X......... Total leach' a------------------sq. ft.
7, Ing 'Ire.
�17 Other Distribution box Dosing tank d 7S�
1-4 Percolation Test Results Performed by.------------------------------------------------------------------------- Date_____----------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit..._.._.__.____.____ Depth to ground water------------------------
f4 Test Pit No. 2................minutes per inch Depth of Test Pit_.___......______.__ Depth to ground water._.__._..__.___._____
----------- ------ ......... ....;;:: --- ........
0 --- ---------- _
Description of Soil.......... ........04,
............... ---4----------------------------f�i....... --------
�4 • �_ e .
U .................................................................................................... ....................................................................................................
W
x ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
............................... ---------------------------- ...... ----------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee 1 u oar of health, 11
d by he , - I
S* ed
Date
Application'Approved By--------------- .. ......... .. .................. ............. ... .. ------------ ....... /7-----
.............................. Date
Application Disapproved for the following reasons: ......................................................................... ......
............................................................................................................................... .......................... -----------------------------------------------
Date
PermitNo........................................................ Issued........................................................
Date
------------
...........................
Fizs
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_. ........OF.�(!` !^ �<�.........................................
Applirtttiun -fur Uiipuitt1 Worko Tanstrurtiun Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: -
1 .
..i
•----------------•------....------- -_- -'"�L-- ----------•--- •-•r•f�'
Loc� f �P Et�G
r
Ad�dress or Lot No.
caner ----------------------------•--•--•.._......Address
j � .�
Installer Address
QType of Building Size Lot............................Sq. feet
Dwelling Y No. of Bedrooms._..�-/___________________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons.-_.____---_________--__-.__ Showers ( ) — Cafeteria ( )
a' Other fixtures ____________________________
W
Design Flow__ ____________SQ__._.._.__.__._____..gallons per person per day. Total daily flow.......... b�4 5.-a____..__._......_....gallons.
W Septic Tank I Liquid capacityl2-�3_gallons Length................ Width................ Diameter-------......... Depth----------------
W Disposal Trench—Igo_..................... Width____--____.._�--___ Total Length.................... Total leaching area------------- ......sq. ft.
x Seepage Pit No____________�_________ Diameter_1 ---- Depth below inlAt_____ _____________ Total leaching area----.--_-.-.-__-_sq. ft.
Z Other Distribution box ( ) Dosing tank ( )_ vh. 1, C • - `'/- 17 - 7 i"
Percolation Test Results Performed bY---------_ ---------------------------------------------------------•-••• Date.............. •--•--•---------•--------
a
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...----..--.--..--.-_...
f� Test Pit No. 2................minutes per inch Depth of Test Pit............-------- Depth to ground water------------------------
----------
Description of Soil - I---•--------- •------ -•---•-•---------�--- �
x
----------------------•---••--••-_-----
UNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------------_----.__--_---.
-------------------------------•----._.. -------------------------------------------------------------------------------------------- ------------------------------------------------------ --
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been- ssued by the oar of health.
�-
ned - , ------------------
--------------------------------
/ Date
Application Approved By.__._....._•-- r ! �`� �,- .7.- _-- _1
�a;---....— /----•--------- Date
Application Disapproved for the following reasons_________________________________________________________________________________________________________________
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS � �(� S• 7-A e ��
BOARD OF HEALTH
A/ J
Trrtifirtttr of filuntpliatta
HIS I ERTIF That the nndivid al ewage Disposal System constructed ) or Repaired ( )
--. ,!.� (!l . " ....... ---------------- --
/� CInstatler
has been installed in accordan with the provisions of :� i`c"t XI of The State Sanitary Code as described in the
V. application for Disposal Works Construction Permit No. __ -__- .2_Z-_______________ dated.... /_ ------ ._____._______.___....
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL F INCTION ATISFACTORY.
DATE--------- --------------------•-- Inspector-------------- ---•••--- ----- -•----_-•---- .....................
THE COMMONWEALTH OF MASSACH TTS
67))
BOARD OF HEALTH
11�
a— L .............OF.............1 .......... ...... --.....------------- 1..........
�i��u�tt� urk,� �un�trttrtivat �rrntit
Permission ' hereby granted. -•---------
------•--•----------------------••••-•----------•----••...__..
to Con Et ( ) or Re air ( ) an Indiv' Iual Sew ge Di; osaystem
�� r�, ..ram�, /`
at No. ' ,l C- C:(/ , 11__.'� ,-- / % reef J c/`�-�
� (f Street (�
as shown on the application for Disposal Works Construction Permit No.......-............ Dated...7_'._C_ _��L�
----------------------
,1 -el ,�.-�.-,
-- --------
ft 7k?..-•.........................•----••----•-----. Board of Heal h
DATE.--(�------ ---:�..__:. . �-••� �' �'
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
h
I
S�vlai
s ,
I ,
r
No.— - = -- Fee----
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zippfication- orlVerr Con5tructionpermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
I)ttoli SIC,'Ili ti —
p Owner Address
-----------------------------
-- - Mays o.�.S'- �"-� ``l E_—^4= _- —— - ----
Installer — Driller a�r4 — Address
Type of Building
Dwelling �--------------------------------------
Other - Type of Building -- No. of Persons--------�----------------------
—____—________
Type of Well Z-" Capacity-------(`-'-------------+ ------------------------------------—-------
Purpose of Well--00"es!—�c _ wCL c�
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate
of Compliance has been issued by the Board of Health.
Signed _�0`_'_/L ------------------------------- -VIA�r_---
date
Application Approved By--- -----------------
���✓✓✓ date
Application Disapproved for the following reasons:-------------------------------------------------------
-------=-------------------------------------------------------------------------
---------------------------------------------------------------------------------------------
date _
Permit No. �f ��= �--------------------—----------------- Issued--------------------------------------
— -- -
--------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
'THIS IS TO/CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired
bY------------------A-1--------1:6-teiv-1114 -------------------------- 1- ---------------------------------------------------------------------------
Installer — —at--- - ------------- =- - -L------ >t� " � J - -
-f -- -------- -----------------------
has been installed in accordance with the provisions o he Town f Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------------------
------- Inspector----------------------------------------------------------—---------------
I � .� 1.. fir; � 1 • i
No. - - Fee--—-----—----
BOARD OF HEALTH
TOWN� 7,OF BARNSTABLE
= Application-*rVell CongtructionPermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (--")an individual Well at:
I-oT /t d D 3 /f c G r.-.c ,OI _ _/a'0_6 (/ - o Y 5( — — - --
Location — Address — Assessors Map and Parcel
f
Ow�er Address
•JaN / f OM0A X
Installer — Driller a� `��% Address
Type of Building u
Dwelling '!o u -e
Other - Type of Building----____ —__—_______ No. of Persons--
4/ °�'---- -------
Type of Well- - - -PJ`----------- — Capacity— -
OOAA s llc W 4�t r ---
Purpose of Well------ -------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
f Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
P place the well in operation until a Certificate ofCompliance has been issued by the Board of Health.`
Signed ,ei_r� a_c J �1�------___— A g _
date
Application Approved By--- _%""`'�— 1=`,."'-� --- -- — 9 %-
-� _ date
Application Disapproved for the following reasons:---------------------- — -
date
Permit No. $ —v�—�—� — ------- Issued —---- --- --
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of compriarlce
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired
—j------------------------------------------------------------------------------—-----_71 --------------by — Installer ) f
at--- —��--� --- --✓'L---—=�— f—— ---— — -- — -has been installed in accordance with the provisions oYthe Town of Barnstable Board of Health Private Well Protection ,
Regulation as described in the application for Well Construction Permit NW --Dated---------------:---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------— -- -- -- — - --— -- Inspector --
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Con5truct ion Permit
No. _ Fee— C'--------
' Permission is hereby granted
to Construct ( Alter ( ), or Repair) an Individual Well at:
QStreet J
as shown on the application for a Well Construction Permit
No.___ ---- -------- ——----- Dated--- —---_--- - ------ — — —
Board of Health
DATE-------------------------------------------------------------------------
-
;aXP IKETp�y�� TOWN OF'BARNSTABLE _ a
+ OFFICE OF -
DA8a9TABL MASK. BOARD OF HEALTH
039.
9�o all �� 367 MAIN STREET
HYANNIS, MASS. 02601
October 3, 1989
Mr. D. A. Scannell
223 Regency Drive
Marstons Mills, Ma 02648
Dear Mr. Scannell: \ r
Please provide a neatly drawn sketch map with all emergency repair, alternation,
and replacement wells with the application.
If you have. any questions, feel .free to call Thomas McKean .at the Health
Department Office (775-1120 Ext. 182).
Sincerely yours,
Thomas A. McKean
Director of Public Health
BOARD OF HEALTH
TOWN OF BARNSTABLE
TM/bs
Enclosure
---------------=-------=-------------
YlUaH 3o pteog
—----------------------------------------- Q---- ___ —--
--------------—--------------------------------------------------------------------- a e p a Q -----------------------------------------------------------— - - ---'ON
4!w1ad uopanjjsuoD 11aM a jo} uopexldde a4l uo umotls se
------------------ aaa��
----------------------- ------------- ----- — — — O
ae 1 a.M.lenp!A►puI ue .neda21 .zo '� ) iaalf/ '� ) ;aniasuOD 01
--------------------------------------------------------------------------y---�-a���ry�a-- �- - paaueiB Agaiay st uoTssiui'ad
------- -- - N
— �F/Y1
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OPOocu6enrv.rlbeNV0110 C.P.C.d HaVeAW,WtkC.p,Coe H— 05.19AS.M
k
GENERALCONOfTIONS I I I I T\ II
1. CODE COMPLIANCE:ALL WORK SHALL COMPLY WITH THE LATEST EDITION OF THE MASSACHUSETTS ONE AND TWO FAMILY BUILDING CODE LOCAL REGULATIONS,B ALL OTHER APPLICABLE CODES A ORDINANCES.
3. DIMENSIONS AND FIELD CONDITIONS:CONTRACTORS SHALL BE RESPONSIBLE FOR VERIFYING ALL FIELD CONDITIONSB I
DIMENSIONS AND COORDINATING NEW WORK WTM THOSE CONDMONS ANO D WENSbMS.THIS PROJECT INVOLVES
EXIENSNECUTIINGANDFRTINOTOEIOSMNOCONOMONSACONSTUCMON.ANVDIWREPANCIESNOMCEDBY THE REMWESTAIRS ID_ , REMOVE ALL POSTS AND FOOTING. /
CONTRACTOR THAT MATERIALLY EFFECT THE DETAIL DESIGN AND,OR THE COST OF THEWORK SHOULDBEREPORTED UP TO DECK. n
IMMEDIATELY TO THE ARCHITWT.
]. ALLPERMITSSHALL REACQUIRED BEFORE ANY WORK IS STARTED IN THE FIELD. __
THE BUB INOWSPECTORSHALLBEKEPTINFORMEDASTOWHEN SMRKBEGWSBATALLCRMCALSTAGWOMING
CONSTRUCTION.
INSURANCE:ANYANO ALL CONTRACTORS WORKING ON THE SITE SHALL CARRY WORKER'S COMPENSATION AND GENERAL Q�
LIFBILITYINSURANCE IC--- ❑ ❑ ❑ ❑ ❑ ®
QUALITY OF WORK
U
1. QUALITY AND STANDARDS OF WORKMANSHIP AND MATERIALS THROUGHOUT SHALL BE OF THE HIGHEST. ❑ ❑
COORDINATION
0
REMOVE GLAZING REMOVE GLAZING UA
t. GENERAL CONTRACTORCTIMMEIALL BE MLYOFSPONSIBLE FOR ORDINACNCONFUCN ALL OF CIPA ,DISCENTPARTSOFTNEDO
RK. UA
INFORM ARCHITECT OUND OAT S O OF TW V COORDINATION CONFLICTS ANTICIPATED,DISCOVERED OR CREATED THAT WILL
EFFE WITHA LPARTIESINVONDNESSORAPPPEARAEOF TNEWO U HOURS OFANENOMICA 1IO SCHEDULE NEETNOS ❑ ❑ V
WITH ALL PARTIES INVOLVED ANp TO APPEAR AT THE SIZE NITMN 24 HOURS OF ANY NOTIFICATION.
SITE PROTECTION AND CLEANING
1. CONTRACTOR SHALL BE FULLY RESPONSIBLE FOR SECURITY AND INTEGRITY OF THE SITE AND FOR MATERIALS STORED OR REMOVE DOOR
TH OERWISE LOCATED THERE.
E
2 STRUCTURE THE WORK SHALL BE RENEWED WITH THE ARCHITECTAND 6HALL INCLUDE MIWMIZINO EXPOSURE OF THE ,
E
STRUCTURE
]. CONTRACTOR SHALL BE DSWE PON61BLSULT CONSULTATION
WITHAND
INNER.LL CONSTRUCTION GNUILDN - F_ REMOVE WALL
4. CONTRACTOR PROTECT CERTAIN
LINEN NTSANb FEATURES.
ARES.0 TANDCONTRACTOR
TOR SHASITEAVDE ANDINONTAIN ALL
PUN TO
PRESERVE ANDPROTIVE BARRIERS EMENA ANDDOUND THE
RRY OUT
THIS
N.BARRIERS
SHALL
NECESSARY PROTECTIVE BARRIERS WITHINFROM
AND AROUND THE HOUSE TO CARRY OUT PR PLAN.BARRIERS SHALL O
LANDSCAPE
AEA REASONABLE DISTANCE FROM THE CONSTRUCTION AREA IN ORDER TO PREVENT ANY DEGRADATION OF THE
ti N L C PE UP SM LINCWTHAT PERIMETER.
S. EQUIPMLEANUP SHALL WINDOWS
DOORS,
LL.,M ITOB CLEANED AND AUTAREAS AFFECTED BYTHEWOLL NEW II -
EQUIPMENT,FIXTURES,WINDOWS AND DOORS,ETC.,ARE 70 BE CLEANED AND ANYLABELS REMOVED.REMOVE ALL DEMO WALLS.SEE
CONSTRUCTION DEBRIS AROUND HOUSE PAYING PARTICULAR ATTENTION TO NAILS AND OTHER FASTENERS THATCOULD BATHROOM PLAN.
PRESENTA HAZARD TO SMALL CHILDREN. L
6. NO FLAMMABLE MATERIALS(OIL PAINTS AND STAINS,GLUES,OIL SOAKED RAGS,ETC)OR OTHER HAZARDOUS MATERIALS
SHALL BE STORED IN OR AROUND THE PREMISES. //
SUBMITTALS /
1. SUBMITSHOP DRAWINGS OF ALL CASINERY AND COUNTERTOPS TO TIME ARCHITECT FOR APPROVAL BEFORE g
COMMENCING FABRICATION. F —� O ee
L SUBMIT FINISH SAMPLES OF ALL FINISHED PANEL TYPMCOLDRS,SAMPLES TO REMAIN ATSITE I\ /I 9!
I SUB MIT PRODUCT LITERATURE ON ALL PROPOSED SPECIFICATIONS,FIXTURES,OR SUBSTITUTIONS TO ARCHITECT FOR I I
APPROVAL
INSULATION F
1. VATHINALLAREASOFWORM PROVOENEWINSULATIONWHEREVERTHEWORKE% SMFRAMINGORFURRWGAT Q
EXTERIOR OF BUILDING,OR ATANY OTHER LOCATION WHERE WSULATINO WILL SIGMFICANTLY REDUCE HEAT LOSS OR REMOVE FIXTURES AND FINISHES ZZIy
REDUCE THE POSSIBILITYOF PIPES FREEZING. R-ISFIBERGL BATTSAT2XGWALLS,R.13RBERGL WBAETSAT2X4 IN BATHROOM -
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MODEL#A1801 HIP (GAS COMPACTED BASE COMPACTED BASE 3:0' 3.0' in, 8. ELEVATIONS BASED ON A DATUM OF 101.11'(APPROXIMATE USGS)OBTAINED FROM
BAFFLE 8.5' - 1.5 1.5
BAFFLE ON BOTTOM) LENGTI1 8'-6" WIDTH 4'-10" DEPTH 5'-7' 5 OUTLET DISTRIBUTION BOX 4.9' EXISTING CATCH BASIN ON REGENCY DRIVE AS SHOWN ON PLAN.
TO BE INSTALLED ON A LEVEL STABLE 48.5 - �* } THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
1500 GALLON SEPTIC TANK OOO GALLON PUMP CHAMBER BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEv.- 44.00 (TYP• g• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
95.00 - 7.9' AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
TANKS SHALL BE INSTALLED ON A LEVEL STABLE BASE PIPES TO BE LAID LEVEL. *ELEVATION OF MYSTIC DISCREPANCIES TO THE DESIGN ENGINEER.
EXISTING 1500 GALLON SEPTIC TANK & CROSS SECTION VIEW LAKE BASE°QNU.s.G.s. 5'MIN_
5 - 500 GAL. CHAMBERS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
PROPOSED 1000 GALLON PUMP CHAMBER DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE T p CHAMBER END VIEW STRUCTURES SHALL BE MADE WATERTIGHT.
NOT TO SCALE _
CHAMBER DETAILS AILS 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
NOT TO SCALE NOT TO SCALE
ZONING REGULATIONS."'OWNER/APPLICANT IS TO OBTAIN SUCH
T FROM APPROPRIATEAUTHORITY.
i DETERMINATION RO
TEST PIT DATA -10 LOADING` 12. OCATEDIUNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH ASE SS
AGENT. Don Desmarais, R.S. THEY SHALL WITHSTAND H-20 LOADING.
G'� 5 t�h ,r" • is
„ :., . °: EVALUATOR: Michael-Pimentel, E.LT., C.S.E. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND
N�5"tg¢9„w = ` April 13, 2005 FINES.
.
DATE:
35828, 14. RED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
TEST PIT#-: 1
WHERE REQUIRED,UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF
ELEV TOP=i 100.0'
LEACHING FACILITY REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
%" +�': 8 t b' COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN
Ai /� £• ELEV WATER= 44.00'*(SEE ABOVE) ACCORDANCE WITH 310 CMR 15.255(3).
0
_ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
0o p fj ° PERC RATE- 2 Min/In
W oh �. � n; °; �� � � SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
5�5.19- z SWING TIE MEASUREMENTS C .. r. ` !`'
4g" r ,
16. PROPOSED PROJECT IS LOCATED WITHIN:
35¢ E ♦ DEPTH OF PERC= 38"-56"r....._.
N7g"39'33•� DESCRIPTION GC DMH#2 HC-1 HC-2 0 ��•.�? TEXTURAL CLASS: � 1
ASSESSORS MAP 64 PARCEL 44
a �{ -- �--
O 43.0p, 4
PUMP COVER IN (1) --- ---- 612' 41.6' - �, 17. OWNER OF RECORD: DAVID B. &ELEANOR R. SANDLER
MYSTIC LAKE
Ssso I1 ,� 0 100.01ADDRESS: 99-60
g3Op7ytS�gF PUMP COVER OUT(2) --- ---- 65.4' 46.1' . l
-
CORNER LEACHING (3) 28.8' 32.5' -- --- " ' 4" 99.6T
Fill CHESTNUT HILL, MA 02467
f 8.
FEMA FLOOD ZONE B&C
CORNER LEACHING (4) 36.2' 24.8' - - ': A Sandy Loam
3/2m AS SHOWN N COMMU PANEL
1
O NITY # 250001 0015 C
19. PLAN REFERENCE:
., 6
- - CORNER LEACHING (5) 68.8' 59.8 --- --- � _ r
N D EX PLAN B Sandy Loam (1.)L.C. PL. 16427D(SHEET 3 OF 3)
° �,_ , CORNER LEACHING (6) 65.2' 63-4' - - 10YR 5/6
SCALE. 80 " 20. DEED REFERENCE-
„ 36 CERTIFICATE 63030
Y
97.00' (1.)L.C. TE#
yy 3 8 g
_ 83'
Perc 6 21. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
56 90 33
MAP 64 : ..:. 22. PROPERTY LINE INFORMATION IS APPROXIMATE, ONLY. THIS PLAN IS
Med. Sand
PARCEL 61 MAP 64 M TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING
N/F STEELE
2.5Y 6/6 WILL NOT ASSUME ANY LIABILITY FOR USES OF THIS PLAN OTHER
` `'� �" C THAN ITS INTENDED PURPOSE..
'PARCEL 43 _ ....�. , :: .
- (TOWN WATER) �;
N/F SAKELLARIDES
/ _ \ WELL WATER 23. CONTRACTOR SHALL PROVIDE THE REQUIRED.MINIMUM CLEARANCES '
( }
e _
BETWEEN THE PROPOSED PIPING AND ANY OTHER EXISTING PIPING
MAP 64' P (FND) �d0 �,, /� (EITHE2 DEPICTED ON PLAN OR NOT).
PARCEL 62 << OFFS T "' No Groundwater,
N/F NICHOLS
LOCUS PLAN
Weeping or Mottling
PROPOSED 5 PROPOSED GEOMEMBRANE „_ , 12D„ Observed ,
SCALE- 1 1000
LOCATED IN REAR 90.00 EXISTING WELL
LINER 40 MIL
LEACHING CHAMBERS ( )
B.M.
OF PROPERTY WHICH IS GREATER` 1
s
tiff Nail in Oak Tree
THAN 100' FROM PROPOSED SAS) /�
PROPOSED EXISTING 1500 GALLON SEPTIC INSTALL 1-1/4"PVC TO HOUSE. JOINTS TO BE MADE
rC. . _ f D-BOX TANK TO BE UTILIZED AS PART OF WATERTIGHT.WIRE PUMP AND FLOATS TO SIMPLEX
� � Elev. -87.45
B.M. o , (Approx.USGS)
QQ o / a / THIS DESIGN. EXISTING OUTLET CONTROL PANEL No. 1-CC2 NEMA-1 MFG. HOOVER '
C.B. Rim � o , o� / I
O
Elev. = 101.11 G� �+ •O- ` TO BE SEALED WATERTIGHT. INSTRUMENTS.
(Approx. USGS) NEMA 4 JUNCTION BOX CORROSION RESISTANT& HOISTING CABLE 7 x 19 STAINLESS STEEL - - 50 - EXISTING CONTOUR
1b i' o� o EXISTING:LEACHING PIT TO LIQUID-TIGHT CABLE CONNECTORS SUPPORTED 1/8 DIA./ 1,760 LB.STRENGTH
h`` O 6 '� °) m " CONDUIT, 50 PROPOSED SPOT GRADES
MHI 1 P AND FILLED WITH D # D BE PUMPED CONNECTORS SUPPORTED BY 1-1/4 PVC
OFFSET - tk - w i � 0
W
ELL O h- .-' / �-,[
�00 / 5 / �H. ¢ o 2"BALL VALVE w/UNIONS SCH.80 PVC
pV CLEAN COARSE SAND JOINTS TO BE MADE WATERTIGHT
DMH#2 4i / C FM / GEORGE FISHER CO. MODEL NO. 560 50 PROPOSED CONTOUR
/ _
�O „ o :..: / �� 1
9 / T .. ..
E/T/C EXISTING UNDERGROUND UTILITIES
MAP O :_=:= P1 Q / / ` ` co
3 2 SCH.40 TO D-BOX
EXISTING CB / gip, / 100.0, O� Ab _ n 24"MAPLE/ = o - -2 SCH.40 TEE w/CLEAN-OUT CAP
RIM=101.0 G / �. 17 OAK P \ N7 - ` ti ALARM ON- W EXISTING WATERLINE
5
O 1
J 4 O c <p\ ( 0082" 3) k, �� ''► ( . 8' LIMP oN _ TEST PIT LOCATION
I o 0000
JO / MAPLE O EXISTING /,: /
QQ�OQ UNDERGROUND / I / 0 3Q� .` PUMP �' 2 BALL CHECK VALVE SCH.80 PVC 100 O O EXISTING 1500 GALLON SEPTIC TANK
..
J O� UTILITY METER 20„OA \ 1 r ` OFF P.S.I. FLOWMATIC MODEL No.208S
O " / D� LU
'�
21 PINE 14"(PAK 1 I 1 Q _ _ O o PROPOSED 1000 GALLON PUMP CHAMBER
O
lk/C'l vP F,1 LO
�Ci Q Q #223 1 1 ( 12 W o �c� ,.
O
\ 4 WEEP HOLE I DISCHARGE P
i
O o� O / \ i 2 WIDE ANGLE CONTROL FLOATS 1/ O E N SCHARGE PIPE "
2 SOLID SCHEDULE 40 PVC FORCEMAIN� o� �. OO 000 O � \ � O I
'� �' �1. 00 O / 86 \ \ I / O' (BARNES 073618) ,.
h / / -- EXISTING L�, 'l 2 SCH.40 PVC DISCHARGE PIPE "
P \
o, O ti �
o O \ 4 SOLID SCHEDULE 40 PVC PIPE
p W W LK _ O O \ I I / � 1. PUMP ON/OFF 120 ACTIVATION
� 4 BEDROOM
o , I I ( rob 2: ALARM ACTIVATION BAR.NES SE511 PUMP 0.5 H.P. 115 V 1750
GC 13
DWELLING / LU (1 2) \ \ \ ` I I 1 ' ,' �6� RPM, IMP. DtA. 5.62", 2'DISCHARGE PASSING DISTRIBUTION BOX
/ STj TOF=94.30' Q O 1
co O AL. LEACHING
500 G CHAMBER
2 LIDS OR EQUAL
N o so
a 1 ,
RAVE \ r �,
/ I \ I I
u MAP 64
GARAG E
C cl; \ I /
EXISTING 1 \ m / W PARCEL 44 I 1 / / / / / / 1(o
\WELL \� \ / (/ 82,764 S.F.± //// / / / / / / / / // / /i5�' �6r 1000 GALLON PUMP CHAMBER
/ / 5
off/ o t> �'`�, I,/ / / I / / / / / // / / / / / / / // // h`t'/ / REV. DATE BY APP'D. DESCRIPTION
N \ \ _ I , / / , , / / / �o DESIGN DATA `
HC 1 / // / / / / / / / / / / / / // f/ / NUMBER OF BEDROOMS 4 RESERVED FOR BOARD
TOTALS: PROPOSED SEPTIC SYSTEM UPGRADE
IP (F7hD) \ / go W l �/ / / f / f/ ff / / / l / /� / f f / T / / DESIGN FLOW 110 GAUDAY/BEDROOM - OF HEALTH USE
TOTAL NUMBER OF CHAMBERS: �5 PREPARED FOR:
TOTAL DESIGN FLOW 440 GAUDAY
TOTAL LEACHING AREA: ,' `608.6 SQ.FT.
LAURIE SANDLER
/ / / / / / / / / / / / / f / / / DESIGN FLOW X 200 % = 880 GAUDAY TOTAL LEACHING CAPACITY: 450.4 GAL./DAY
EXI TING / / 8 - / i i / / / , / / �` USE EXISTING 1500-GALLON SEPTIC TANK LOCATED AT
WELL EXISTING CB / /-'86-
/ /
RIM =95.15' �, � ,� 'Ile � �� �.• � � / f / / l 1 I / / / � - DOSING & STORAGE REQUIREMENTS 223 REGENCY DRIVE
/
/
o , 1 I INSTALL 5 LEACHING CHAMBERS MARSTONS MILLS, MA 02648
"A6 'tN '(`L� -(per ga' 66' �� C° co voi N 1 DESIGN FLOW: 440 GPD
I !
o I WA AP ITY 4 , /DAY
S DE LL C AC DOSING REQUIRED. CYCLES/04-
S7 a ( = SCALE: 1 INCH 20 FT. DATE: APRIL 28, 2005
S 440 GPD/4 110 GAL/CYCLE
E 0 ALLON 1 _� PROPOS D 1 00 G 94 �� + - A AY MAP 64 4P,
PUMP CHAMBER 35¢ 1 j9 E (LENGTH g'WIDTH)(2�(2 HIGHO(747GPDP S/F.F) 166.9 GAL/AY USE PROPOSED 1000 GALLON PUMP CHAMBER J"OF o 10 20 o ao FEET
( ) O( ) ( )
°r JOHN L. � PREPARED BY:
N/F HOWES O o CHURC IL TAN E RE UIRED BETWEEN PUMP CHURCH ILL ,DISTANCE Q
U
m
I
(WELL WATER) �� JR. JC ENGINEERING, INC.
ON AND PUMP OFF FLOATS: CIVIL
BOTTOM CAPACITY
- r 2854 CRANBERRY HIGHWAY
110 GAL/CYCLE 250 GAUFT - 0.44-FT/CYCLE 18
/ ( LENGTH x WIDTH ) (.74 GPD/S.F.) = GAUDAY (USE 0.58'TO PROVIDE FOR 32 GALLONS OF BACKFLOW) EAST WAREHAM, MA 02538
'
_ 508.273.0377
,
SITE PLAN (48.5'x 7.9') (.74 GPD/S.F.) = 283.5 GAUDAY STORAGE REQUIRED ABOVE WORKING LEVEL: 440 GAL.
SCALE: 1"=20' STORAGE PROVIDED ABOVE WORKING 605 GAL. Drawn By: MCP Designed By:MCP Checked By. MCP JOB No.838